Sent to MA State Representatives:
I have been practicing obstetrics and gynecology in Massachusetts for over 15 years. I have worked with certified nurse midwives during my residency (training) and I have served as a back up for CNMs as a board certified obstetrician-gynecologist. I have great respect for the philosophy and practice given by CNMs who have completed post-graduate training in a credentialed program. CNMs are extremely capable of handling uncomplicated obstetrical care. I have also seen how despite best intents and efforts of a certified nurse midwife, a mother's health can easily be jeopardized without a physician's extensive knowledge and surgical expertise as back up. Obstetricians are held to a high standard-- after medical school we enter competitive 4- year residency, and we are required to re-certify every 6 years (as compared to 10 years for orthopedists, internists and others, for example). It is a field that, rightly so, requires close oversight as the health of a women is greatly threatened during pregnancy, delivery and postpartum. The lack of sufficient training and oversight for "certified professional midwives" and lay midwifery is most concerning for assuring women's health.
I am a mother as well and I am forever grateful for the superb care by an obstetrician when I was pregnant with my first-born son. I had an infection, which endangered my son's health, leading to a premature delivery. Now he is turning ten years old, soon to be entering 4th grade and he is healthy and I am healthy and for that I am beyond grateful.
I am deeply concerned regarding MA Senate Bill 2341
An Act RELATIVE TO CERTIFIED PROFESSIONAL MIDWIVES AND ENHANCING THE PRACTICE OF NURSE-MIDWIVES.
As a highly regarded colleague states,
"The most alarming thing about this bill is the following statement in the bill,
'The practice of midwifery shall not constitute the practice of medicine, certified nurse-midwifery, or emergency medical care to the extent that a midwife advises, attends, or assists a woman during pregnancy, labor, natural childbirth, or the postpartum period.'
As obstetrician/ gynecologists we are fully aware that while labor is a physiologic process, there are a myriad of potential complications a woman might endure during her pregnancy or postpartum period. This bill would essentially say women’s health care falls outside the realm of medical care, and the licensed practitioners wouldn’t be subject to the same degree of oversight other providers of women’s health care are."
I would strongly urge you to consider defeating this bill for the safety of women.
Sincerely yours,
Kitsa Catherine Kondylis-deBlois, MD, FACOG
Tuesday, July 27, 2010
Tuesday, June 22, 2010
Mission Accomplished
Friends,
Please do not associate this quote with the most inane man who ever presided over the United States! My endurance event is indeed over with no residual issues other than a mild but painful sunburn on my back, multiple blisters on my feet and a post-race high. Indeed, I have been waiting for that infamous "delayed-onset muscle soreness" to kick in, but so far, so good and it is now 3 days post-race. My focus on the race was to finish it and so indeed this mission was accomplished. I was able to drive myself home 90 minutes after the race and bask in the endorphins.
It is the logistics that overshadow the training on the days prior to a race such as a half-ironman (in this case, 72.3 miles). A poor plan for hydration, nutrition and pain management can sabotage even the best preparatory (physical) training for a long race, especially for a novice such as myself. I had read in "The Runners Body" that runners do not die of hypernatremia (too much sodium in the blood) but that there were several well-documented cases of runners dying of the opposite, hyponatremia, due to excessive hydration. The night prior to the event, I attended a seminar which emphasized hydration and salt intake. While the presenter advised that nobody should change their plans the night prior to a race, I found the practical advice on salt intake invaluable.
The weather on race day was predicted to be sunny, 90F and humid after noon-- about the time I would start the last leg, a 13.1 mile run, the half-marathon. Up until the seminar, my formal nutrition plan only included adequate sugar replacement for energy (to replete "glycogen stores") on the bike segment and relying on the aid stations to determine what I would take in for hydration and sodium intake. That night, my revised nutrition plan formally included salt and fluid intake. Given the environmental conditions for the race, I also decided to revise my goal time for the run. (Indeed, Ms. Superego was booted out of the race planning that very night. She had entertained a goal pace of 9 minutes/mile.)
The swim was great fun in its entirety and the 58- mile biking segment became a grind only at the very end. As for the dreaded run, the goals were maintained-- to never walk, to keep at a 9:15 pace between aid stations, to stop at every single aid station and to focus on hydration, salt tablets and pretzels. Due to the nutrition plan, potty runs and chatting with the friendliest of volunteers at the aid stations, my ultimate running pace seemed tortoise-like-- 11 min/mile-- but to me, it was the ideal ending for a long run and a long race. I cried running down the finishing chute!
Please do not associate this quote with the most inane man who ever presided over the United States! My endurance event is indeed over with no residual issues other than a mild but painful sunburn on my back, multiple blisters on my feet and a post-race high. Indeed, I have been waiting for that infamous "delayed-onset muscle soreness" to kick in, but so far, so good and it is now 3 days post-race. My focus on the race was to finish it and so indeed this mission was accomplished. I was able to drive myself home 90 minutes after the race and bask in the endorphins.
It is the logistics that overshadow the training on the days prior to a race such as a half-ironman (in this case, 72.3 miles). A poor plan for hydration, nutrition and pain management can sabotage even the best preparatory (physical) training for a long race, especially for a novice such as myself. I had read in "The Runners Body" that runners do not die of hypernatremia (too much sodium in the blood) but that there were several well-documented cases of runners dying of the opposite, hyponatremia, due to excessive hydration. The night prior to the event, I attended a seminar which emphasized hydration and salt intake. While the presenter advised that nobody should change their plans the night prior to a race, I found the practical advice on salt intake invaluable.
The weather on race day was predicted to be sunny, 90F and humid after noon-- about the time I would start the last leg, a 13.1 mile run, the half-marathon. Up until the seminar, my formal nutrition plan only included adequate sugar replacement for energy (to replete "glycogen stores") on the bike segment and relying on the aid stations to determine what I would take in for hydration and sodium intake. That night, my revised nutrition plan formally included salt and fluid intake. Given the environmental conditions for the race, I also decided to revise my goal time for the run. (Indeed, Ms. Superego was booted out of the race planning that very night. She had entertained a goal pace of 9 minutes/mile.)
The swim was great fun in its entirety and the 58- mile biking segment became a grind only at the very end. As for the dreaded run, the goals were maintained-- to never walk, to keep at a 9:15 pace between aid stations, to stop at every single aid station and to focus on hydration, salt tablets and pretzels. Due to the nutrition plan, potty runs and chatting with the friendliest of volunteers at the aid stations, my ultimate running pace seemed tortoise-like-- 11 min/mile-- but to me, it was the ideal ending for a long run and a long race. I cried running down the finishing chute!
Friday, April 30, 2010
Elle est tres jolie, n'est ce pas? La bicyclette, bien sur!
Rockbuster 2010
As expected, Rockbuster 2010 was a whole lotta fun. I think that the folks you meet can make a potentially good race experience a great experience. Part of the bonding experience is wow-ing over gadgets and thanks to Gene of GearWorks, I got to demo a beautiful test bike, the dual suspension Specialized Epic mountain bike. (I loved it so much that I wanted to kiss it. I insisted my rackmates try it out after the race. The consensus was that indeed it is a phenomenal bike. Oh, yeah, it costs about $2400.) What I most appreciate about off-road events is that there is not much of the usual strutting around as with regular triathlons and duathlons-- you know, that swagger that elite athletes have? People in off-road events are more, pun slightly intended, "down to earth". Sure, the elites are present, but nobody really cares-- we all will get muddy, possible road rash, perhaps a good trajectory over the handlebars (AKA a "superman") on the downhills. More likely to get a flat tire too. I was, per usual, whining about the weather to my neighboring rackmate, Serenity. ("I'm 100% Greek you know, this weather would have caused us to go extinct.") Her husband, Mike, was her designated pit crew and photographer. We three laughed so much prior to the race that there was only time for a brief warm-up (and little time to really play with the bike). The race was relaxed as both Serenity and I had "handicaps" from the get-go-- she was nursing a left achilles tendinitis and I had to put forth 70% effort on an already very very tired body due to my relentless training for the upcoming Half-Ironman. Medals were won mainly as a result of finishing the race. The medals and making a new friend with a similar interest (and a lot more, like ice climbing!!!) was icing on the cake.
Monday, April 19, 2010
Decision point
Friends,
Do you remember the early video games? PacMan, Donkey Kong? (Yes, dating myself). I loved some of the games that were absolutely chaotic but when I played Tetris, I got a sense of accomplishment b/c/o the "neatness" and symmetry since all the pieces just seemed to fall together with just a little bit of planning. As you know I am sharing quite openly in cyberspace the "trials and tribulations" of trying to keep the balance as a mom, OB and aspiring athlete and I share the times in which the pieces do NOT fall into place so neatly.
Private practice for OB/Gyns is particularly hard on family and free time because of the burden of calls (ie the frequent lack of sleep and resultant chronic fatigue) as well as the need for maintaining a high volume in the office to make a profit. I recall a local practice telling me that each OB practitioner sees 50 (FIFTY) patients in an office day, which I calculated to be one patient every 6 minutes (and that is with no break). I did not pursue the practice as I felt that patient care would be short- changed-- unless time for proper documentation to ensure there were no errors would be taken at the end of the day, after official office hours. (Delaying documentation for the end of the day hinders maintaining meticulous records -- there is recall bias, lapses in impressions, details, etc. Electronic medical records have indeed improved the quality of documentation, but practitioners whom I have informally surveyed state that the EMRs do not save time, EMRs merely allow the practitioner to document better with the use of pick lists as well as reminders for documenting family history, allergies, etc. ) Office volume and call frequency of this particular group would ensure family time would suffer. Ultimately I found a larger group practice with EMRs, but again, there was an issue of office volume and income. There was a proposal in the group for OBs to expand office hours in evenings and perhaps on weekends to increase volume. (Ummmm, as well as taking 24-36 hour calls one to two times a week? And so HOW does an obgynmom maintain the work/family/health balance?! )
So in pursuit of balance, perhaps to allow at least a few pieces fall together in some order-- I'm moving into academic medicine. Academia provides the ability to practice medicine without the stress of maintaining volume. That and the appeal of teaching and mentoring a new generation of physicians and being on the cutting edge of knowledge and technology is irresistible. A not-so-minor trade-off in joining academics is less pay and this may translate to a drop off in fitness and definitely competitiveness. We know that money helps promote health-- numerous studies show that wealthier people live longer. A study of Nobel laureates indicated that those who are wealthier live longer. A recent survey by USAT of its members indicates that the average income per triathlete is high-- well into the six-figures. These folks know what they are doing --cross -training reduces risk of injury, thus allowing one to continue to exercise, thus increasing odds of good health and longevity. As for me personally, the drop in income puts me at a second decision point --in order to gain a competitive advantage in triathlon, a significant financial investment is necessary-- the coaching, the bikes, timing and training devices are costly. With the income change, can I be satisfied with stating to myself, "Hey, keep training only for fitness, keep it noncompetitive, ride the older/slower bike (without reaping the fruits of training in terms of faster times or medals)?"
I believe that many folks who are suffering in this "job-less recovery" -- the unemployed, underemployed, are experiencing something similar-- a decision point in which loss of time and/or money dictates a change in direction for obtaining or maintaining health (and in some cases a sacrifice in competitive advantage). Will the sacrifices of the employee in a mature economy translate into better health for the developing world worker (or, taken cynically, will the CEOs of the companies who "outsource" be the sole beneficiaries)? Can the "health pie" be big enough?
Do you remember the early video games? PacMan, Donkey Kong? (Yes, dating myself). I loved some of the games that were absolutely chaotic but when I played Tetris, I got a sense of accomplishment b/c/o the "neatness" and symmetry since all the pieces just seemed to fall together with just a little bit of planning. As you know I am sharing quite openly in cyberspace the "trials and tribulations" of trying to keep the balance as a mom, OB and aspiring athlete and I share the times in which the pieces do NOT fall into place so neatly.
Private practice for OB/Gyns is particularly hard on family and free time because of the burden of calls (ie the frequent lack of sleep and resultant chronic fatigue) as well as the need for maintaining a high volume in the office to make a profit. I recall a local practice telling me that each OB practitioner sees 50 (FIFTY) patients in an office day, which I calculated to be one patient every 6 minutes (and that is with no break). I did not pursue the practice as I felt that patient care would be short- changed-- unless time for proper documentation to ensure there were no errors would be taken at the end of the day, after official office hours. (Delaying documentation for the end of the day hinders maintaining meticulous records -- there is recall bias, lapses in impressions, details, etc. Electronic medical records have indeed improved the quality of documentation, but practitioners whom I have informally surveyed state that the EMRs do not save time, EMRs merely allow the practitioner to document better with the use of pick lists as well as reminders for documenting family history, allergies, etc. ) Office volume and call frequency of this particular group would ensure family time would suffer. Ultimately I found a larger group practice with EMRs, but again, there was an issue of office volume and income. There was a proposal in the group for OBs to expand office hours in evenings and perhaps on weekends to increase volume. (Ummmm, as well as taking 24-36 hour calls one to two times a week? And so HOW does an obgynmom maintain the work/family/health balance?! )
So in pursuit of balance, perhaps to allow at least a few pieces fall together in some order-- I'm moving into academic medicine. Academia provides the ability to practice medicine without the stress of maintaining volume. That and the appeal of teaching and mentoring a new generation of physicians and being on the cutting edge of knowledge and technology is irresistible. A not-so-minor trade-off in joining academics is less pay and this may translate to a drop off in fitness and definitely competitiveness. We know that money helps promote health-- numerous studies show that wealthier people live longer. A study of Nobel laureates indicated that those who are wealthier live longer. A recent survey by USAT of its members indicates that the average income per triathlete is high-- well into the six-figures. These folks know what they are doing --cross -training reduces risk of injury, thus allowing one to continue to exercise, thus increasing odds of good health and longevity. As for me personally, the drop in income puts me at a second decision point --in order to gain a competitive advantage in triathlon, a significant financial investment is necessary-- the coaching, the bikes, timing and training devices are costly. With the income change, can I be satisfied with stating to myself, "Hey, keep training only for fitness, keep it noncompetitive, ride the older/slower bike (without reaping the fruits of training in terms of faster times or medals)?"
I believe that many folks who are suffering in this "job-less recovery" -- the unemployed, underemployed, are experiencing something similar-- a decision point in which loss of time and/or money dictates a change in direction for obtaining or maintaining health (and in some cases a sacrifice in competitive advantage). Will the sacrifices of the employee in a mature economy translate into better health for the developing world worker (or, taken cynically, will the CEOs of the companies who "outsource" be the sole beneficiaries)? Can the "health pie" be big enough?
Friday, February 26, 2010
Personal Event Schedule
Friends,
This will not be a thoughtful post, instead I thought I'd put out my event schedule for this year in cyberspace so that I remain committed to it. Problem with going into a second year of athletics (and this coming May will mark my first year of being coached to race, not just showing up at a starting line) is that I now have some events with a "personal best" to look back on... and compare... and try not to set up unrealistic expectations!
So... here it goes:
2010 Event (Dare -I -say -"Race") Schedule:
Sunday 2/28/10: Hyannis Half- Marathon (My first 1/2 M-- and looks like it will snow!)
April: Two "C Races" (Defined as: No peak, No taper, 70% effort during race & then No recovery-- just keep on training!): Wrentham Duathlon and Rockbuster Off-Road Duathlon (the latter of which is really really really fun)
May: One "C Race": US Coast Guard Duathlon; Possible Half Century Bike Ride
June: Patriot Half-Ironman Triathlon (Anchoring event of the season as it requires a huge commitment in training thus, "A Race" b/c of taper and peak, effort is just get through this endurance event and then a loooong recovery- phew!)
July ??? Olympic Distance triathlon and/or a sprint distance tri w/ ocean swim
August: Lowell Olympic Distance Triathlon (A Race)
September: TDD Triathlon (B/C Race) and? Hale Off-Road Duathlon
October: Tufts 10K (women's- only) Road Race, Boston and
MSG Off-Road Duathlon
This will not be a thoughtful post, instead I thought I'd put out my event schedule for this year in cyberspace so that I remain committed to it. Problem with going into a second year of athletics (and this coming May will mark my first year of being coached to race, not just showing up at a starting line) is that I now have some events with a "personal best" to look back on... and compare... and try not to set up unrealistic expectations!
So... here it goes:
2010 Event (Dare -I -say -"Race") Schedule:
Sunday 2/28/10: Hyannis Half- Marathon (My first 1/2 M-- and looks like it will snow!)
April: Two "C Races" (Defined as: No peak, No taper, 70% effort during race & then No recovery-- just keep on training!): Wrentham Duathlon and Rockbuster Off-Road Duathlon (the latter of which is really really really fun)
May: One "C Race": US Coast Guard Duathlon; Possible Half Century Bike Ride
June: Patriot Half-Ironman Triathlon (Anchoring event of the season as it requires a huge commitment in training thus, "A Race" b/c of taper and peak, effort is just get through this endurance event and then a loooong recovery- phew!)
July ??? Olympic Distance triathlon and/or a sprint distance tri w/ ocean swim
August: Lowell Olympic Distance Triathlon (A Race)
September: TDD Triathlon (B/C Race) and? Hale Off-Road Duathlon
October: Tufts 10K (women's- only) Road Race, Boston and
MSG Off-Road Duathlon
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